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Current aspects of antirheumatic therapy in pregnancy planning, during pregnancy and breastfeeding
Z Rheumatol. 2021 Sep 28:1-8. doi: 10.1007/s00393-021-01095-z. Online ahead of print.ABSTRACTActive rheumatic disease is a known factor for increased fetomaternal risks during pregnancy. Remission or inactive disease should therefore be targeted to reduce these risks by using pregnancy-compatible antirheumatic drugs as recommended by international guidelines. Teratogenic antirheumatic drugs, such as mycophenolate, methotrexate, cyclophosphamide and thalidomide should be stopped about 3 months prior to conception. Leflunomide is a weak human teratogen that should be stopped and eliminated with cholestyramine prior to concep...
Source: Zeitschrift fur Rheumatologie - September 28, 2021 Category: Rheumatology Authors: Celine H äfeli Frauke F örger Source Type: research

Management of immune thrombocytopenia in women: current standards and special considerations.
Authors: Rodeghiero F, Marranconi E Abstract Introduction: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder, with an incidence rate of 20-40/million adults/year and an estimated prevalence in women of childbearing age of 24.5/million.Areas covered: Authors discuss management of ITP in pregnancy, treatment-related toxicity, delivery, neonatal thrombocytopenia and breastfeeding, and other women's specific issues. Search of papers published between January 1990 and December 2019 was done on PubMed using combinations of the keywords below. Distinction between ITP and other thrombocytopenias in pregnancy...
Source: Expert Review of Hematology - January 7, 2020 Category: Hematology Tags: Expert Rev Hematol Source Type: research

Transfer of monoclonal antibodies into breastmilk in neurologic and non-neurologic diseases
Conclusions The current data are reassuring for low mAb drug transfer to breastmilk, but further studies are needed, including of longer-term effects on infant immunity and childhood development.
Source: Neurology Neuroimmunology and Neuroinflammation - May 26, 2020 Category: Neurology Authors: LaHue, S. C., Anderson, A., Krysko, K. M., Rutatangwa, A., Dorsey, M. J., Hale, T., Mahadevan, U., Rogers, E. E., Rosenstein, M. G., Bove, R. Tags: Autoimmune diseases, Multiple sclerosis Views [amp ] Reviews Source Type: research

Treatment of Women with Multiple Sclerosis Planning Pregnancy
We present recent data on disease-modifying therapies (DMT) before/during pregnancy and while breastfeeding, with treatment recommendations.Recent FindingsObservational data support the safety of injectable DMTs (glatiramer acetate, interferon-beta) for use in pregnancy, while some oral DMTs might be associated with fetal risk. Monoclonal antibodies (mAbs) before pregnancy such as rituximab or natalizumab likely do not pose significant fetal risks, but can cross the placenta with neonatal hematological abnormalities if given in the second trimester or later. Breastfeeding is associated with decreased risk of postpartum rel...
Source: Current Treatment Options in Neurology - March 30, 2021 Category: Neurology Source Type: research

Rituximab and Canakinumab Use During Lactation: No Detectable Serum Levels in Breastfed Infants
ConclusionThe lack of detectable levels of rituximab and canakinumab in the sera of breastfed infants reflects the poor oral bioavailability of these biologics and helps to promote their use in breastfeeding patients.
Source: Rheumatology and Therapy - May 17, 2021 Category: Rheumatology Source Type: research

Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions
Conclusions We determined minimal transfer of rituximab into mature breast milk. The RID for rituximab was less than 0.4% and well below theoretically acceptable levels of less than 10%. Low oral bioavailability would probably also limit the absorption of rituximab by the newborn. In women with serious autoimmune neurologic conditions, monoclonal antibody therapy may afford an acceptable benefit to risk ratio, supporting both maternal treatment and breastfeeding.
Source: Neurology Neuroimmunology and Neuroinflammation - November 11, 2019 Category: Neurology Authors: Krysko, K. M., LaHue, S. C., Anderson, A., Rutatangwa, A., Rowles, W., Schubert, R. D., Marcus, J., Riley, C. S., Bevan, C., Hale, T. W., Bove, R. Tags: Autoimmune diseases, Multiple sclerosis Article Source Type: research

Primary diffuse large B cell lymphoma of the lactating left breast. A case report and review of the literature.
CONCLUSION: Although bilateral primary DLBCL during breast feeding is very rare, mothers should be examined for breast mass during pregnancy and breastfeeding term. Surgery may be choice for local control of disease and supplementary radiotherapy, chemotherapy, and immunotherapy should be administered promptly following surgery. KEY WORDS: Bilateral, Lactating, Primary Breast Diffuse Large B Cell Lymphoma. PMID: 33427203 [PubMed - in process]
Source: Annali Italiani di Chirurgia - January 13, 2021 Category: Surgery Tags: Ann Ital Chir Source Type: research

Neuroimmunological Disorders
Multiple sclerosis is a disease that tends to affect women during their childbearing years. Although relapse risk decreases during pregnancy, patients should still be optimized on disease-modifying therapy before and after pregnancy to minimize gaps in treatment. Exclusive breastfeeding may reduce the chances of disease relapse postpartum, and many disease-modifying therapies are considered to be safe while breastfeeding. Treatments for other neuroimmunologic disorders such as neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, neurosarcoidosis, and central nervous syste...
Source: Neurologic Clinics - February 14, 2023 Category: Neurology Authors: Edith L. Graham Source Type: research

A Systematic Review on Predisposition to Lymphoid (B and T cell) Neoplasias in Patients With Primary Immunodeficiencies and Immune Dysregulatory Disorders (Inborn Errors of Immunity)
Conclusions Though this is not a comprehensive summary of malignancies in PIDDs, or even lymphoproliferative disease in this area, this review summarizes the Medline-indexed published reports of B and T lymphomas in patients with PIDDs. This report highlights the diversity of malignant lymphoproliferative disorders in setting of PIDDs, and its associated challenges of diagnosis and treatment. The pathological classification and nomenclature for the lymphoid malignancies with variably reported and postulated underlying mechanisms were inconsistent and inadequate for many of these published reports. A wide range of treatmen...
Source: Frontiers in Immunology - April 15, 2019 Category: Allergy & Immunology Source Type: research

Immunosuppressive treatment for primary membranous nephropathy in adults with nephrotic syndrome
CONCLUSIONS: This updated review strengthened the evidence that immunosuppressive therapy is probably superior to non-immunosuppressive therapy in inducing remission and reducing the number of patients that progress to ESKD. However, these benefits need to be balanced against the side effects of immunosuppressive drugs. The number of included studies with high-quality design was relatively small and most studies did not have adequate follow-up. Clinicians should inform their patients of the lack of high-quality evidence. An alkylating agent (cyclophosphamide or chlorambucil) combined with a corticosteroid regimen had short...
Source: Cochrane Database of Systematic Reviews - November 15, 2021 Category: General Medicine Authors: Thilo C von Groote Gabrielle Williams Eric H Au Yizhi Chen Anna T Mathew Elisabeth M Hodson David J Tunnicliffe Source Type: research

Interventions for focal segmental glomerulosclerosis in adults
CONCLUSIONS: No RCTs, which evaluated corticosteroids, were identified although the KDIGO guidelines recommend corticosteroids as the first treatment for adults with FSGS. The studies identified included participants with steroid-resistant FSGS. Treatment with cyclosporin for at least six months was more likely to achieve complete remission of proteinuria compared with other treatments but there was considerable imprecision due to few studies and small participant numbers. In future studies of existing or new interventions, the investigators must clearly define the populations included in the study to provide appropriate r...
Source: Cochrane Database of Systematic Reviews - February 28, 2022 Category: General Medicine Authors: Elisabeth M Hodson Aditi Sinha Tess E Cooper Source Type: research